Implementation Guide, 3

TeamSTEPPS® Long-Term Care Version

Keys to success at each phase include involvement of the right people, use of information-driven decision making, and careful planning before acting. The following paragraphs provide an overview of each of the phases including goals and objectives, key actions, and recommended tools and resources.

Action Planning Worksheets

Action Planning Worksheets for each step are contained in the following pages.

TeamSTEPPS Action Planning Worksheet — Step 1

Step 1. Create a Change Team

Objective: To assemble a team of leaders and staff members with the authority, expertise, credibility, and motivation necessary to drive a successful TeamSTEPPS Initiative.

Essential Change Team Members

Change Team Member

Name(Staff Position)

Key Characteristics

Primary Role(s)

Senior Leader

"Executive Sponsor"

Enough "clout" in the nursing home to implement new approaches to care.

Authority to allocate time and resources necessary to achieve team's aim(s).

Authority over all areas that will be affected by the change.

Sponsors and visibly supports the Change Team.

Creates the vision of the new system for the nursing home as a whole.

Leads the spread of specific changes throughout the nursing home or system.

May choose to become a member of the Change Team.

Clinical or Technical Expert

"The Champion"

Expert knowledge of the relevant clinical subject matter.

Understands the processes of care within workspace where changes will occur.

Good working relationship with colleagues and front-line leaders.

Interest in driving/leading change

Responsible for being members of the instructor cadre.

Responsible for coaching and role-modeling the team behaviors and skills.

Step 2. Define the Problem, Challenge, or Opportunity for Improvement

Objective: To specifically state the problem, challenge, or opportunity for improvement that will be targeted by the TeamSTEPPS Intervention and to identify the involved process. What specifically do you want to "fix" or improve? Note: When the word "problem" is used, it broadly refers to any challenges you choose to tackle or opportunities for improvement that would most likely be positively affected by a TeamSTEPPS Initiative.

Briefly state the problem, challenge, or opportunity for improvement that will be improved through resident care teamwork. What is it that you will fix or improve?

What is the evidence to support your problem selection?

Adverse event due to a breakdown in team skills (e.g., communications, situation monitoring, mutual support/backup).

Near miss(es) due to breakdowns in team skills.

Staff members are concerned that we could have an adverse event due to breakdowns in team skills.

Step 3. Define the Aims of Your TeamSTEPPS Intervention

Objective: To succinctly state in measurable terms exactly what you hope to achieve with your TeamSTEPPS Intervention — what will be achieved, who will be involved, and when and where the change will occur.

State at least one team process aim:

A team process aim states your goal for how well your staff will carry out your TeamSTEPPS Intervention as you designed it. Examples include (a) a goal for how often your staff will use the intervention team tool (e.g., brief, SBAR, I PASS the BATON) or (b) a goal for how many staff members will receive resident care team training.

What do we want to achieve? (e.g., number of staff who receive team training; increase in rate of use of a specific teamwork tool)

Who will be involved in the change? These are the persons who are involved in the "what you want to achieve" listed above, such as the staff members who receive resident care team training or who use the teamwork tools (list by staff position or title, not individuals' names).

When will the improvement occur? Within what timeframe?

State at least one team outcome aim.

A team outcome aim is directed at the changes that occur in team performance as a result of your staff carrying out your intervention. It states your goal for improvements in your staff's team performance.

What do we want to achieve? (e.g., increased staff perception of good team behavior; increased observed effective team communication among staff)

Who will be involved in the change? Whose team behavior will change? (List by staff position or title, not individuals' names.)

When will the improvement occur? Within what timeframe?

State at least one clinical outcome aim.

The clinical outcome aim is your goal for improvements in clinical results due to improved team performance.

What do we want to achieve? (e.g., increased resident satisfaction; improved performance on a relevant health care quality measure [e.g., increased use of SBAR in communicating resident information]; decreased rates of adverse events or near misses)

Who will be involved in the change? Whose behavior will change and/or which resident populations will be affected?

Step 4. Design a TeamSTEPPS Intervention

Identify opportunities for process improvement using team strategies/tools:

In the space below, flowchart or map the process — where the target problem or opportunity for improvement occurs. Write down the process steps as they currently occur and identify who is doing what, when, with what tools. Use extra sheets of paper if needed.

Then mark with an "X" the risk points in the process where things could go wrong and lead to a recurrence of your target problem.

Finally, identify with arrows where in the process team strategies and tools might eliminate or mitigate the risk points and prevent the problem from recurring.

Review the evidence-base and search for best practices. Have other groups successfully used specific team tools to reduce similar process risk points? Are there any relevant resident safety requirements, expert recommendations, or best practices? If so, list below and cite source or reference.

Draft your TeamSTEPPS Intervention. State what team strategies and tools (e.g., brief, debrief, STEP, SBAR, I PASS the BATON) will be used, who will use them, and when and where they will be used.

Step 5. Develop a Plan for Testing the Effectiveness of Your TeamSTEPPS Intervention

Objective: To develop a method to determine if your TeamSTEPPS Intervention achieved your aims. Did it work?

Complete the following table for each one of your aims.

State aim:

Individual (staff position) on Change Team responsible for data collection, analysis, and presentation:

Measures and target ranges for that measure: Measure must answer if you achieved your aim.

Study design:

Pre- and post-intervention study

Other design. Describe:

"Test subjects" or data source and control group: Pre- and post-intervention study - baseline (pre-intervention) data from the study group serves as the control. Other control group. Describe:

Data collection methods: For both baseline and preintervention data, identify who will collect the date, when, where, and how.

Baseline (preintervention data):

Postintervention data:

Methods for data analysis and interpretation: What calculations will you perform with your data to determine if you achieved your aims? Examples include event counts, rates (percentages), survey scores, and time-to-event occurrences.

Step 7. Develop a Plan for Sustained Continuous Improvement

Objective: To develop a plan for continuous process improvement with your TeamSTEPPS Intervention, including plans for ongoing assessment of the effectiveness of the intervention, sustainment of positive changes, and identification of opportunities for further improvements.

Monitoring Plan The monitoring plan will measure over time if the intervention continues to be effective. The plan can be a continuation of your testing plan, although you may want to simplify it by reducing the frequency of measurements. Describe your monitoring plan:

Step 8. Develop a Communication Plan

Objective: To create a communication plan targeting major stakeholders that will generate initial and on-going support for the TeamSTEPPS Initiative and promote the maintenance and spread of positive changes.